Provider Demographics
NPI:1568990349
Name:OLY FAMILY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:OLY FAMILY CHIROPRACTIC, INC.
Other - Org Name:OLY FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARI
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:831-332-0907
Mailing Address - Street 1:1211 4TH AVE E STE 200
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4280
Mailing Address - Country:US
Mailing Address - Phone:253-380-9464
Mailing Address - Fax:
Practice Address - Street 1:1211 4TH AVE E STE 200
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4280
Practice Address - Country:US
Practice Address - Phone:253-380-9464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60678194111N00000X
WACH60650662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty